1417471533 NPI number — MELISSA CATHERINE NICHOLSON M.A., LMFT

Table of content: MELISSA CATHERINE NICHOLSON M.A., LMFT (NPI 1417471533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417471533 NPI number — MELISSA CATHERINE NICHOLSON M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLSON
Provider First Name:
MELISSA
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUDZACK
Provider Other First Name:
MELISSA
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417471533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 SPINNING WHEEL RD.
Provider Second Line Business Mailing Address:
SUITE 125
Provider Business Mailing Address City Name:
HINSDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-292-6941
Provider Business Mailing Address Fax Number:
630-974-6263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 SPINNING WHEEL RD.
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
HINSDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-292-6941
Provider Business Practice Location Address Fax Number:
630-974-6263
Provider Enumeration Date:
07/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  166.001234 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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